US9421366B2 - Methods of treating medical conditions by population based encoding of neural information - Google Patents

Methods of treating medical conditions by population based encoding of neural information Download PDF

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US9421366B2
US9421366B2 US14/651,433 US201314651433A US9421366B2 US 9421366 B2 US9421366 B2 US 9421366B2 US 201314651433 A US201314651433 A US 201314651433A US 9421366 B2 US9421366 B2 US 9421366B2
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signal
neural
neural tissue
sensation
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Dustin Tyler
Daniel Tan
Matthew Schiefer
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Case Western Reserve University
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/02—Details
    • A61N1/04—Electrodes
    • A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
    • A61N1/0551—Spinal or peripheral nerve electrodes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36003—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of motor muscles, e.g. for walking assistance
    • A—HUMAN NECESSITIES
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    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A—HUMAN NECESSITIES
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    • A61N1/36067—Movement disorders, e.g. tremor or Parkinson disease
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    • A61N1/36103—Neuro-rehabilitation; Repair or reorganisation of neural tissue, e.g. after stroke
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    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
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    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
    • A61N1/36128—Control systems
    • A61N1/36189—Control systems using modulation techniques

Definitions

  • the present invention relates to methods of treating medical conditions by employing patterned intensity modulation of neural tissue.
  • Sensory perception is a complex process that involves many circuits and levels of processing in the neural pathways before it reaches conscious perception. Loss of sensation is one of the more devastating consequences of upper limb amputation. Natural sensation is critical in an artificial limb. Sensation is important for fine motor control, an individual's sense of self, perception, and affective communication. No viable chronic replacement for sensation has previously been demonstrated. Those with limb loss must rely on visual and auditory feedback from the device motors for prosthesis control. The prosthesis is perceived by the user as a foreign tool extending beyond, but not as part of, the user's body. In addition to improved control of the prosthetic limb, sensory perception is important to providing a sense of embodiment and in the reduction of phantom pain.
  • sensory perception is a complex process that involves many circuits and levels of processing in the neural pathways before it reaches conscious perception.
  • stimulation of sensory pathways in subjects that can directly describe the sensations of the stimulation it is possible to gain insight into the processing of these circuits. While the description is based on the sensory system, embodiments of the present invention extend to any neural input to a higher level processing neural system.
  • the present invention generally relates to patterned intensity modulation of neural tissue.
  • Certain embodiments provide a method of treating medical conditions by providing an electrode and modulating stimulation parameters delivered by the electrode.
  • the stimulation parameters that are modulated relate to stimulation intensity and are varied according to input parameters and time.
  • Intensity refers to the parameters of any particular pulse waveform that affects the number of neural fibers activated by the stimulation pulse.
  • the parameters that affect intensity vary in a pattern or function that is not a scalar or is not the same distorted waveform shape produced by the input parameters.
  • the intensity of stimulation can be varied as either a function or pre-defined pattern that is dependent on inputs, variables, and/or time. In addition to intensity of stimulation, even the choice of each individual pulse waveform (i.e.
  • ⁇ or psi may be varied for each pulse.
  • Such a mode of patterned-intensity stimulation is referred to herein as a “population-based encoding” of neural information where the intensity and pulse shape determines which of the patient's axons are activated.
  • apopulation-based encoding of neural information where the intensity and pulse shape determines which of the patient's axons are activated.
  • information is introduced into the neural system by way of altering the “population” code.
  • Non-limiting examples of neural tissue that can be modulated are axons or fibers of a nerve such as a peripheral nerve including an autonomic nerve or a somatic nerve. Autonomic nerves include parasympathetic and sympathetic nerves.
  • the neural tissue can also be axons of the central nervous system, such as axons of the brain or spinal cord or their divisions.
  • the present invention provides a method of introducing more information to a neural system of a patient through a population code.
  • the method comprises placing a therapy delivery device in communication with a patient's neural tissue and activating the therapy delivery device.
  • the method further comprises varying a stimulation parameter and field within the patient's neural tissue to change the population of fibers of the neural tissue that are active.
  • the present invention provides a method of treating a medical condition in a patient suffering therefrom comprising placing a therapy delivery device in communication with the patient's neural tissue and activating the therapy delivery device.
  • the method further comprises modulating a stimulation parameter delivered by the therapy delivery device.
  • the stimulation parameter relates to stimulation intensity and varies according to a stimulation input parameter and time.
  • the present invention provides a method of improving sensory perception in an individual in need thereof.
  • the method comprises placing an electrode in communication with the patient's neural tissue and activating the electrode.
  • the method further comprises modulating a stimulation parameter delivered by the electrode.
  • the stimulation parameter relates to stimulation intensity and varies according to a stimulation input parameter and time.
  • FIG. 1 illustrates the stability and selectivity of implanted cuff electrode systems according to embodiments of the present invention.
  • FIG. 1A schematically illustrates three cuffs with 20 channels that were implanted in the forearm of a subject: a 4-contact spiral cuff on the radial nerve of the forearm and 8-contact FINEs on median and ulnar nerves. Electrode leads were tunneled subcutaneously to the upper arm and connected to open-helix percutaneous leads via Letechepia connectors. Single-channel, charge-balanced, mono-polar stimulation was provided with the Universal External Control Unit (UECU) nerve stimulator.
  • FIG. 1B schematically illustrates typical sensation locations at threshold stimulation levels at week 3 post-operatively.
  • FIG. 1C schematically illustrates repeated, weekly overlapping threshold locations of channels M 2 , M 3 , M 4 , M 5 , and M 8 over weeks 3 through 10 Post-op indicated consistent location perception. These locations were prioritized due to their potential for hand grasp sensation feedback. Locations remained relatively stable regardless of stimulation waveform used.
  • FIG. 1D is a chart illustrating mean, normalized charge density for all channels on the median (blue), ulnar (green), and radial (red) cuffs shown as the solid line. Shaded areas indicate the 95% confidence interval, with no indication of raising thresholds. An unbiased, step-wise search determined the threshold. Frequency was held constant at 20 Hz.
  • FIG. 2 illustrate waveform patterns.
  • FIG. 2A is a classic square, charge-balanced, cathodic-first stimulation pattern. Parameters such as pulse amplitude (PA), pulse width (PW) and interpulse interval (IPI) or frequency (f) are held constant in most neural stimulation paradigms.
  • FIG. 2B is schematic illustration of a percept area of a subject. In general, PA and PW modulated the percept area of recruitment at suprathreshold levels with constant parameter stimulation. M 5 showed a channel-specific recruitment pattern as PW was increased from 24 to 60 ⁇ s. M 3 showed that percept area recruitment also was achieved by increasing PA from 1.1 to 2.0 mA. These recruitment patterns match digital nerve innervation patterns.
  • FIG. 2A is a classic square, charge-balanced, cathodic-first stimulation pattern. Parameters such as pulse amplitude (PA), pulse width (PW) and interpulse interval (IPI) or frequency (f) are held constant in most neural stimulation paradigms.
  • FIG. 2C is a variable frequency, bursting pattern where constant frequency, f tap , stimulation was pre-pulsed with 2-10 pulses at 250-500 Hz resulted in a tapping sensation. Constant stimulation alone produced paresthesia.
  • FIG. 2D (top plot) is an example of a full-scale modulation, using a sinusoidal (1 Hz) PW envelope that produces a natural sensation of pulsing pressure.
  • FIG. 2D (bottom plot) illustrates the resulting stimulation waveform where the interpulse interval (IPI) is 0.1 sec (10 Hz). Stimulation trials typically used an IPI of 0.01 sec (100 Hz) according to exemplary methods of the present invention.
  • IPI interpulse interval
  • FIG. 3 is a full-scale modulation, sinusoidal PW envelope.
  • FIG. 3A schematically illustrates that at threshold (B th ), a pulsing pressure was felt at the bold circle area (M 3 , M 4 , M 8 , blue).
  • B tingle a secondary threshold
  • Increasing the PW to a secondary threshold (B tingle ) introduced an additional pulsing paresthesia, which typically covered a larger area that overlapped the pressure location.
  • Increasing the PW further caused the area of paresthesia to increase while the area of pressure did not.
  • Light moving touch was described as if someone were lightly brushing their skin with a finger, and was consistently unidirectional for a given stimulus parameter set (R 1 , R 4 , red).
  • FIG. 3B is a chart of a psychometric rating of PW max Indicating a Clear Relationship Between PW and the Strength of the perceived intensity.
  • the subject was provided 5 PW max levels (100, 114, 131, 150, 167 ⁇ s) and each level was presented 3-6 times in random order.
  • FIG. 3C is a chart illustrating threshold windows for natural sensation measured on every channel of a median cuff. Pressure occurred at B th (green), was accompanied by paresthesia at B tingle (black line, yellow), and was overwhelmed by paresthesia at B Mask (red). The largest PW windows for a particular channel were found when PA was lowest. Higher levels of stimulation were avoided for M 6 due to pain response.
  • FIG. 4 illustrates small-scale, offset (SSO) modulation.
  • FIG. 4A is a typical example of a SSO modulation using sinusoidal (1 Hz) PW with offset stimulation on M 4 (solid, red line).
  • PW pk-pk 90-95 ⁇ s was the lowest stimulation level that produced constant pressure sensation.
  • the threshold for pulsing pressure from full-scale modulation is shown (dotted, blue line).
  • FIG. 4B is chart illustrating that the PW min-max window that produced a sensation of constant pressure was strongly influenced by the PA, which altered both the size and the location of the window. Frequency was found to have a weaker effect on the window but was found to affect the intensity (D). At PA of 0.5 mA there was no response.
  • FIG. 4C is a chart illustrating that contralateral pressure matching indicated frequency can control intensity of constant pressure sensation.
  • the subject was provided SSO modulation with IPI set to 50, 20, 10, 5 or 2 ms (20, 50, 100, 200 or 500 Hz) on channel M 4 and asked to match the perceived pressure with his contralateral hand.
  • Perceived constant pressure intensity was on the order of 0-500 grams ( ⁇ 1 lb).
  • FIG. 5 illustrates functional tasks with sensory feedback.
  • FIG. 5A is a photograph depicting that without the sensory feedback system enabled, the subject was unable to provide an appropriate amount of grip force in a delicate task of holding a cherry while removing the stem.
  • FIG. 5B is a photograph illustrating that with the sensory feedback enabled, the subject knows when contact occurs and can successfully grip the cherry without damaging the fruit.
  • FIG. 5C is a chart illustrating that sighted and blinded performance with the sensory feedback on or off during the cherry task shows a clear improvement in functional capability, even under sighted conditions.
  • FIG. 5D is a chart illustrating that ratings for embodiment statements on the Embodiment Questionnaire show a significant agreement over control statements when sensory feedback is on and an significant improvement from functional task experiences without sensory feedback.
  • a medical condition includes any biological function, disease, or disorder where improvement in the patient's condition is desired.
  • a “patient” is a mammal and preferably is a human being suffering from an undesirable medical condition.
  • a “therapy delivery device” includes any device that can stimulate a patient's neural tissue, including, but not limited to, an electrode/lead and/or a catheter/drug pump.
  • the terms “a,” “an,” and “the” include at least one or more of the described element unless otherwise indicated.
  • the term “or” refers to “and/or” unless otherwise indicated.
  • Embodiments of the present invention provide neural interfaces to chronically elicit stable, repeatable, and natural tactile percepts in humans with upper limb amputation.
  • Such neural interfaces can produce multiple, independent sensory perceptions over the entire phantom hand.
  • Stimulation parameters are also provided. For example, changing the parameters of a time-varying pattern of stimulation intensity produce multiple, complex, natural sensations in a single location.
  • Such parameter changes can produce a variety of exemplary touch perceptions such as tapping, constant pressure, light moving touch, and vibration in a subject's with limb amputation.
  • Percept area and intensity can be controlled by stimulation strength and frequency, respectively.
  • sensation at the fingertips and sensation of the opening span of the artificial hand enables the subject to perform delicate manipulations not otherwise possible. With sensation, a subject can better integrate an artificial hand as a natural part of themselves.
  • Embodiments of the present invention provide a neural interface for the chronic restoration of tactile perception. Such a neural interface can be used for artificial limbs.
  • An embodiment of a device of the present invention comprises nerve cuffs containing multiple, independent stimulus channels. Each cuff can be implanted around a peripheral nerve, avoiding piercing protective neural tissues.
  • three nerve cuff electrodes were placed around nerves in the forearm of one amputee with a wrist disarticulation and in the upper arm of a second amputee with a below elbow amputation as schematically depicted in FIG. 1A .
  • One subject had been implanted for over 18 months and the second for over 11 months.
  • the selected interface technologies were a self-sizing spiral nerve cuff electrode and 8-channel Flat Interface Nerve Electrodes (FINE).
  • the FINE maintains the nerve in an oblong configuration to facilitate selective stimulation.
  • cortical stimulation in which electrodes are inserted into the sensory cortex of the brain.
  • distributed, punctate sensations may be created and controlled across the phantom hand.
  • the described multi-channel nerve cuff electrodes produce chronic, stable, and selective restored sensation in humans.
  • Such electrodes and accompanying devices provide stable, multiple, and natural tactile sensations at many punctate locations.
  • Peripheral Interface is Selective and Stable
  • FIG. 1A In weekly experiments, monopolar electrical nerve stimulation on any one of 20 possible channels implanted around the median, radial, and ulnar nerves of the subject was provided as schematically illustrated in FIG. 1A .
  • the threshold for sensory perception was determined by slowly increasing the stimulus intensity until the subject indicated that he felt something.
  • the subject verbally described the sensation and sketched the perceived location on a hand drawing.
  • stimulation produced sensation at 19 unique locations on the perceived limb as schematically illustrated in FIG. 1B , illustrating the high degree of selectivity achieved with the multi-channel cuffs.
  • the locations of percepts were repeatable and stable as indicated by FIG. 1C .
  • Percepts were produced at many locations, but included thumb and index finger tips, which were highly desirable because the prosthetic hand typically applies force at those locations during functional tasks. All perceived locations were consistent with innervation patterns for the respective median, ulnar and radial nerves on which the electrodes were implanted, suggesting that the sensory pathways from the amputated limb and the subject's perception are not affected by cortical remapping, confirming earlier short-term studies.
  • PA pulse amplitude
  • PW pulse width
  • IPI interpulse interval
  • Variation in stimulation therefore, is important to perception, but tapping is not as useful as perception of pressure.
  • the pulse width therefore, ranged from 0 ⁇ s to B ⁇ s (see FIG. 2D and methods below).
  • the subject reported a natural pulsing pressure sensation at 1 Hz and described it, “as if I was feeling my own pulse or heartbeat, just like putting my fingers here,” as he demonstrated his fingers against his jugular pulse in the neck.
  • the sensation was described as repeatedly pushing “very lightly” on a spatially localized area of the skin as indicated by FIG. 3A .
  • the tap matched the frequency, f mod .
  • the sensation became pulsing pressure with increasing intensity, but with the same frequency of f mod .
  • the subject was asked to rate his perception of 5 different values of peak pulse width, B.
  • the pulsing sensation was described as similar to pressing on the tip of a ball-point pen.
  • the perceived sensory modalities across all 19 active channels and all trials included pulsing pressure (86.1%), light moving touch (7.3%), or tapping (7.3%).
  • the response to the modulated pulse width stimulation on all channels during a single experimental sessions and aggregated over multiple sessions is shown in Table 1 and Table 2.
  • Table 1 shows example sensation modalities during a single experimental session. Channels were modality specific. Pressure was as if a finger was pressing on the area unless otherwise described. M 6 transitioned to a sensation of a needle within a vein at higher stimulation.
  • U 4 occasionally produced sensation and was thought to be located on the edge or off the nerve.
  • Table 2 shows average channel response for each cuff with full-scale modulation, where n is the number of unique, natural responses per channel, per experimental visit. Natural, non-tingling sensation was achieved on every channel with sinusoidal varying PW stimulation. Columns may not sum to 100% since some observations lead to multiple sensations.
  • B Mask a certain limit
  • B>B mask >B tingle paresthesia dominated the natural sensory perception as indicated by FIG. 3C .
  • SSO Small-Scale, Offset
  • the stimulation waveform was refined further to produce the perception of constant pressure rather than a pulsing pressure.
  • the typical size of pulse with modulation, PW pk-pk was surprisingly as small as 5 ⁇ s.
  • the stimulation pulses had an IPI 0 of 0.01 sec and the modulation envelop frequency, f mod , was 1 Hz.
  • the PW offset was set to approximately 90% of the B th required to produce the natural pulsing sensation (see FIG. 4A and methods below). Constant pressure on all locations on the palmar side (M 2 , M 3 , M 4 , M 5 , U 1 ) for all channels was achieved as shown in Table 3. A PW pk-pk of 1-10 us when PW offset was set to the appropriate level generated a sensation of continuous pressure. If the PW pk-pk or PW offset was too large or too small, the resulting sensation was either paresthesia or the natural sensation generated by full-scale modulation.
  • Constant Freqs 5-500 Hz
  • the size and range of the PW pk-pk window needed to produce constant pressure was found to be dependent on the stimulation channel, PA 0 , PW offset , and IPI as indicated in FIG. 4B .
  • the lightest intensity (score 1) occurred at the longest IPI (0.2 sec) and the subject described the sensation as if, “a finger was just resting on the surface of the skin.”
  • the greatest intensity (score 13) was at the shortest IPI (0.002 sec) and was reported as “white knuckle” forceful pressure.
  • the ultimate goals of restoring sensation are to improve functional use of the prosthesis, improve subject confidence using the prosthesis, and provide a sense of embodiment with the prosthesis.
  • Sensation is critical to performance of tasks that require more precise control of the grasp pressure.
  • the subject plucked the stem off of a cherry with his intact hand while holding the cherry with his prosthetic hand.
  • the subject had to apply enough pressure to the cherry to secure it in order to remove the stem without applying too much pressure that damaged or crushed the cherry as indicated by FIGS. 5A and 5B .
  • the test was administered with and without providing sensory feedback to the subject through force-sensitive-resistor sensors mounted on the fingertips of the prosthetic hand. In both cases, half of the tests were administered while the subject could see the cherry being grasped and hear the prosthesis motors and the other half had vision and hearing 100% occluded.
  • Methods of the present invention relate to chronic, multi-location, multi-perception sensory feedback system to improve functional performance and quality of life.
  • sensory perception is controlled.
  • pulse width, pulse amplitude, stimulation frequency, and the patterns by which these parameters are varied potential control of the spatial extent, intensity, and quality of perception has been demonstrated.
  • the electrodes are able to attain this level of control in multiple spots of a single nerve such that there is a complete and independent control of 19 different locations on the hand with only three implanted cuffs with a total of 20 electrical contacts.
  • Tasks requiring fine prosthesis control e.g. pulling the stem from a cherry, which were not reliably possible without sensation even when sighted, are made possible with sensory feedback, even when blinded.
  • Sensation will alleviate the visual and attentional demand typically required to use a myoelectric prosthesis.
  • Feeling the grasp of an object and the pressure applied further augments confidence in task performance.
  • the subject reports feeling like he is grabbing the object, not just that he is using a tool to grab the object.
  • the time-variant stimulus train recruits spatially distinct populations at different times, creating a non-uniform pattern of activation.
  • a small population of axons is supra-threshold and actively firing. Because the pulse width never decreases below this level, this population of the neurons will always activate at the stimulation frequency, which is a constant, SA-type pattern. Only at higher pulse widths will there be sufficient stimulation to activate other, more distant neurons. That population will have a more transient or pulsing activation pattern that mimics the pattern more typical of RA/PC fibers.
  • intensity was modulated by the stimulation frequency.
  • the quality of the sensation was controlled.
  • constant pressure, pulsing pressure, flutter, tapping, vibration, or paresthesia with a single stimulation channel were produced and the perceptions were all at the same perceived location on the hand. More than 1.5 years after implant, these results continue to remain stable and do not show any indication that they will change.
  • Embodiments described herein provide chronically stable sensory neuromodulation system in a human that produces multiple modes of sensation at multiple points in the perceived hand and that perception significantly improves performance using a prosthesis.
  • Time-variant modulation of stimulation controls perceived sensory quality and frequency of stimulation produces a natural, graded intensity of sensation. This is a fundamental shift in stimulation paradigms and can have applications in the neural interfacing and sensory modulation fields, particularly in applications with perception-related outcomes, such as pain.
  • this population-based encoding by way of patterned stimulation intensity can apply to any suitable afferent or autonomic neural system that is an input to other neural systems such as, for example, somatosensory perception, autonomic control of homeostasis, and perception of pain.
  • Other medical conditions or functions include modulation of pain by TENS, spinal cord stimulation, or any other suitable means of neural excitation for modulation of pain; taste; regulation of swallowing via stimulation of sensory afferents in the oral-pharyngeal tract; gastric reflux; autonomic regulation, such as blood pressure via baroreceptor stimulation, insulin regulation via stimulation of pancreatic nerves, and appetite via stimulation in the enteric nervous system; auditory restoration via cochlear nerve stimulation or cochlear implants; sexual sensation and/or enhancement; and/or incontinence, voiding and other genito-urinary regulation.
  • Embodiments of methods can be used for, but not limited to, spinal cord stimulation, peripheral nerve stimulation, mechanical stimulation, and/or deep brain stimulation.
  • Embodiments of the present invention also apply to fields outside of the medical field.
  • methods of the present invention could provide sensory input in a haptic interface and could be used in robotics, gaming technology, and other man-machine interfaces.
  • the inclusion criteria for human subjects included upper-limb, uni-lateral amputees, age 21 and older, and who are current users of myoelectric prosthesis or prescribed to use one. Potential subjects were excluded for poor health (uncontrolled diabetes, chronic skin ulceration, history of uncontrolled infection, active infection) and if significant, persistent pain existed in the residual or phantom limb.
  • Multi-contact nerve cuff electrodes were placed in the residual limb of a 46 year-old male who has a unilateral wrist disarticulation from work-related trauma. At the time of implant, the subject was 18 months post-amputation and had been a regular user of a myoelectric prosthesis for 7 months.
  • Eight-contact Flat Interface Nerve Electrodes (FINEs) were implanted on the median and ulnar nerves and a 4-contact spiral electrode was implanted on the radial nerve.
  • FINE opening size for the nerve was 10 mm wide by 1.5 mm tall for both the median and radial nerves. The internal diameter of the spiral electrode was 4 mm for the radial nerve.
  • Electrodes were in the mid-forearm as indicated by FIG. 1 and connected to percutaneous leads that exited through the upper arm.
  • Implanted components were manufactured by Ardiem Medical (Indiana, Pa.) and sterilized with Ethylene Oxide by Ethox International (Buffalo, N.Y.). The subject was discharged from the hospital the same day as the surgery.
  • the implanted electrodes were allowed to stabilize for three weeks before experimental stimulation was applied. During the recovery period, subject reported no adverse sensations in the implanted locations and no abnormal phantom sensations. In following weekly sessions, experimental stimulation was applied through each contact for up to 10 sec. For all trials, the subject was blinded to the stimulation. Following stimulation, the subject would describe any perceived sensation and sketch its location on a hand diagram. Trials with no stimulation were randomly intermixed to assure no subject bias.
  • the stimulation system includes a computer that controls stimulation parameters and sends the commands to a single board computer running xPC Target (Mathworks, Inc.).
  • the stimulator is the Universal External Control Unit (UECU) and is controlled through the xPC Target.
  • UECU Universal External Control Unit
  • An isolator provides optical isolation between devices plugged into the wall and the subject. To prevent overstimulation, the charge density was limited to less than 50 ⁇ C/cm 2 and the stimulation kept to less than 50% duty cycle during all stimulation protocols.
  • the UECU is a custom stimulator manufactured by Ardiem Medical (Indiana, Pa.). It has 24 channels of controlled-current stimulation outputs, with a maximum stimulation amplitude of 5.6 mA, a maximum stimulation pulse width of 255 ⁇ s and a compliance voltage of 50 V.
  • the UECU provides monopolar, biphasic, charge-balanced, cathodic-first stimulation pulses with common anode. Anodic return was through a 2′′ ⁇ 4′′ surface electrode on the dorsal of the upper arm immediately proximal to elbow.
  • the generic stimulation waveform, ⁇ is a train of pulses, ⁇ , separated by an interpulse interval, IPI.
  • the pulse parameters, ⁇ are selected to produce neural excitation.
  • the pulse parameters, ⁇ , and IPI are a function of measured external inputs over time, ⁇ (t), and time, t.
  • Sensory perception is a result of processing by higher-order neural circuits that are sensitive to both the activation and to the pattern of changes in activation of the peripheral receptor.
  • stimulation of the peripheral nerve is expected to be dependent on changes in activation, so ⁇ and IPI are defined as a function of the desired tactile perception and time, i.e.
  • ⁇ ( ⁇ (t), t) and IPI( ⁇ (t),t) Eq. 1).
  • the findings show that perception is controlled by the time-dependent change of the parameters, referred to as time-variant modulation. Variation of each of the parameters of stimulation were systematically examined according to each of the following conditions.
  • a bursting pattern is defined as
  • IPI ⁇ ( ⁇ , t ) ⁇ 2 ⁇ ⁇ or ⁇ ⁇ 4 ⁇ ⁇ ms ⁇ t ⁇ 50 ⁇ N ⁇ ⁇ ms 1 f tap ⁇ ⁇ ms ⁇ t > 50 ⁇ N ⁇ ⁇ ms ⁇
  • N is the number of bursting pulses, generally between 2 and 10 ( FIG. 2 .C). Stimulating with a Time-Variant Pulse Width, PW( ⁇ i ,t) Full-Scale Modulation.
  • the pulse width therefore, ranged from 0 ⁇ s to B ⁇ s as indicated in FIG. 2D .
  • Small-Scale, Offset (SSO) Modulation Small-Scale, Offset (SSO) Modulation.
  • Threshold was determined using the Single-Interval Adjustment Matrix, which is an unbiased, adaptive staircase method. The parameters were set for a target performance of 50% with true stimulation provided 50% of the time. The threshold search was defined as complete after 12-16 reversals. Stimulation was applied for 1 sec and repeated upon subject request. Stimulation frequency was held constant at 20 Hz. To prevent overstimulation of sensation, stimulation pulse amplitude (PA) and pulse width (PW) was incremented by 0.1 mA and 10 ⁇ s steps until the rough threshold was determined. Then PA was held constant at one step (0.1 mA) below the rough threshold while the adaptive staircase method was used to determine a precise PW threshold with 1 ⁇ s resolution.
  • PA stimulation pulse amplitude
  • PW pulse width
  • SSO modulation was provided on channel M 4 .
  • the subject was presented with 5 seconds of stimulation, then requested to match the pressure sensation on the contralateral hand by pressing on the manipulator for 5 sec. The last two seconds of the matched pressure data was averaged per trial.
  • the manipulator was shaped to resemble the perceived sensation and was pressed on the same palmar location in the contralateral hand as the perceived sensation.
  • the manipulator was shaped with an approximately 1 ⁇ 2′′ diameter circle flat tip with rounded edges out of balsa wood. This manipulator was placed on top of a Flexiforce sensors model A201 (0-1 lb range) manufactured by Tekscan, Inc. (South Boston, Mass.). The sensor was calibrated and the DAQ sampled the sensor at 10 Hz.
  • the subject plucked the stem off of a cherry with his intact hand while holding the cherry with his prosthetic hand.
  • Pressure measurement on the prosthetic hand was achieved by mounting thin Flexiforce sensors (model A201) on the thumb and index finger tips.
  • a bend sensor also was mounted to provide prosthesis opening feedback.
  • the sensory feedback stimulation used was SSO with intensity controlled by linear mapping of sensor force to pulse repetition frequency over the range of 10-125 Hz.
  • the test was administered 60 times without providing sensory feedback to the subject.
  • the test was also administered 30 times while providing sensory feedback to the subject.
  • an adapted embodiment questionnaire was given to the subject immediately following functional testing.
  • the questionnaire has 9 statements with which the subject can respond on a ⁇ 3 to +3 scale from strongly disagree to strongly agree, respectively. Three statements correlate with embodiment, while 6 are control statements for task compliance and suggestibility. The order of statements is randomized.
  • the questionnaire was adapted by changing the phrase “touch of the investigator” to “touch of the objects [manipulated during functional tasks]”. Pooled from functional tests on both subjects, “Sensory feedback off” embodiment questionnaire results were compared to the “sensory feedback on” embodiment questionnaire.

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